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Clinical Decisions Final > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Pregnancy has what effect on MAC? when does it return to normal?

A

decreased by 40%; ~three days after pregnancy

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2
Q

What are the treatments for HoTN during delivery?

A

phenylephrine/ephedrine, supp O2, L uterine displacement, IVF

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3
Q

Blockade of anterior nerve root fibers causes blockade of what? posterior?

A

anterior - efferent motor and autonomic outflow; posterior - somatic and visceral sensation

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4
Q

Why do obstetric patients desaturate so quickly?

A

at term, MV increases by 50% while at the same time FRC decreases by 20%

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5
Q

Why are obstetric patients usually anemic?

A

at term, blood volume increases by 1-1.5L while plasma volume increases by 45%

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6
Q

What components add to the increased cardiac output of obstetric patients? How much is cardiac output increased?

A

HR increases 15-20%; SV increases 30%; CO increases 40%

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7
Q

What factors contribute to GERD in obstetric patients?

A

decreased LE sphincter due to displacement of stomoch by uterus, elevated progesterone, hypersecretion of gastric acid

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8
Q

What is human chorionic somatomamotropin?

A

a hormone similar to growth hormone; it modifies the metabolic state of the mother to facilitate energy supply to the fetus

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9
Q

What noticeable changes does human chorionic somatomamotropin have on the obstetric patient?

A

relative insulin resistance (hyperglycemia); increases insulin levels; pancreatic beta cell hyperplasia; gestational diabetes

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10
Q

What causes decreased uterine blood flow?

A

systemic hypotension, aortocaval compression, uterine vasoconstriction (catecholamines, vasoactive drugs), contractions

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11
Q

What are the two parts of stage 1 labor?

A

early labor - cervix gradually effaces and dilates up to 3cm; active labor - cervix dilates more rapidly and contractions are longer, stronger and closer together

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12
Q

Where do patients generally feel pain during labor? which dermatomes are these?

A

stage 1 - (mostly visceral) lower abdomen, lumbosacral area, gluteal region, thighs (T10-L1)
stage 2 - onset of perineal pain (S2-4 [pudential nerve])

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13
Q

What is placenta accreta?

A

abnormally deep attachment of the placenta to the myometrium

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14
Q

Up to what sensory level does a patient need to be blocked for C-section?

A

T4

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15
Q

Pain relief during labor needs to be provided at what sensory level during each stage?

A

stage 1 - T10-L1; stage 2 - T10-S4

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16
Q

Why is it important to preload a patient with IVF? how much should be given?

A

blood loss, HoTN associated w/ sympathetic blockade; 500-1000cc crystalloid

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17
Q

PDPH is a greater risk in what neuraxial technique? why?

A

epidural; because a larger needle is used

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18
Q

What are the most important factors for spread/block height in neuraxial anesthesia?

A

spread (spinal) - baricity (CSF volume important for isobaric); block height (epidural) - injection site

19
Q

What are the most important factors for duration in neuraxial anesthesia?

A

spinal - dose; epidural - choice of LA

20
Q

What are the most important factors for onset in neuraxial anesthesia?

A

spinal - pKa; epidural - pKa

21
Q

Which causes more profound HoTN, spinal or epidural?

A

spinal

22
Q

How far do you advance the catheter once in the epidural space?

A

3-5cm

23
Q

What is the treatment for PDPH?

A

IV hydration, 500mg caffiene, (epidural blood patch 12-20cc)

24
Q

What are standard aspiration prophylaxis given and in what dose?

A

bicitra 30cc, metoclopramide 10mg, famotidine (Pepcid) 20mg

25
Q

What is dystocia? what are typical causes?

A

abnormal or difficult labor; abnormal fetopelvic relations, dysfunctional uterine activity

26
Q

What are reasons for emergent delivery?

A

amnionitis, fetal distress, impending maternal death, maternal hemorrhage, umbilical cord prolapse, genital herpes with ruptured membranes

27
Q

What are causes of partum hemorrhage?

A

placenta previa, abruptio placentae, uterine rupture

28
Q

What are complications of the fetus/placenta/uterus?

A

fetus - distress, breech birth; placenta - amnionitis, umbilical cord prolapse, placenta accreta, abruptio placentae, placenta previa; uterus - uterine rupture

29
Q

What are the diagnoses/treatment for umbilical cord prolapse?

A

diagnosis - fetal bradycardia; treatment - steep T-berg, push contents back into pelvis then emergency C-section

30
Q

What is treatment for breech birth presentation?

A

before delivery - internal/external cephalic version (spinning the baby around while in the womb); vaginal delivery - forceps; mandatory c-section (surgeon preference)

31
Q

What is the presentation of placenta previa? treatment?

A

presentation - painless vaginal bleeding; treatment - bed rest before 37 weeks, c-section

32
Q

What is the most common cause intrapartum death?

A

abruptio placentae

33
Q

What are the causes, signs and treatment for abruptio placentae?

A

causes - bleeding into endometrium; signs - painless vaginal bleeding with uterine contraction and tenderness; treatment - vaginal delivery ok unless fetal destress

34
Q

What are common causes of uterine rupture?

A

dehiscence of scar from previous uterine surgery, trauma from forceps, spontaneous from prolonged labor

35
Q

What are presentations of uterine rupture? treatment?

A

possible presentations - hemorrhage, fetal distress, loss of uterine tone, HoTN; treatment - IVF and laparotomy (possible hysterectomy)

36
Q

What constitutes pregnancy-induced HTN?

A

systolic 140mmHg+ (or rise of 30+), diastolic 90mmHg+ (or rise of 15+)

37
Q

What constitutes pre-eclampsia? eclampsia?

A

pre-eclampsia - HTN after 20th wk/resolved after delivery, proteinuria (>500mg/d); eclampsia - pre + tonic-clonic seizures

38
Q

Treatment for pre-eclampsia?

A

bed rest, sedation, antihypertensives, magnesium sulphate (to prevent convulsions)

39
Q

What is HELLP syndrome?

A

pre-eclampsia associated w/: hemolysis, elevated liver enzymes, low platelet count

40
Q

What is amniotic fluid embolism?

A

entry of amniotic fluid into maternal circulation via a break in the uteroplacental membrane

41
Q

What does amniotic fluid embolism cause? how does it present?

A

PE, DIC, uterine atony; presents as tachyapnea, cyanosis, shock, bleeding, pulmonary edema, seizures, LV dysfunction

42
Q

What is treatment for amniotic fluid embolism? why might it be ineffective?

A

ACLS; aortocaval compression impairs resuscitation with CPR

43
Q

What drugs are useful in treating post-partum hemorrhage?

A

pitocin, methergin (for uterine atony),

Clinical Decisions Final (4 decks)

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